Collaboration helps get members back to work
Collaboration helps get members back to work
CM, vocational rehabilitation work together
Through a team approach that involves case managers, vocational rehabilitation counselors, and on-site job coaches, CIGNA Group Insurance has developed a successful return-to-work program for members who are severely injured or experience debilitating illnesses.
"Our vocational rehab staff works very closely with case managers to help establish return-to-work plans and goals. It’s a very successful approach that we’ve been using for some time. We identify early on those claimants who are likely to need vocational rehabilitation and move them along the continuum to get them the services they need," says Angelica Greene, MHS, CRC, manager, vocational expert resources for CIGNA Group Insurance in Pittsburgh.
The process of getting injured or seriously ill members into the vocational rehabilitation program begins with the first telephone call from a case manager.
"Within the first week that the claim arrives, the case managers get in touch with someone. It may be the claimant or their physician or their employer, depending on the patient’s condition. In many cases, the contact is with all three," Greene says.
When the member is ready to look at return-to-work options, the case manager alerts the telephonic vocational rehabilitation counselor.
Later on, if the member needs face-to-face services, such as job coaching or someone to visit the work site to look for job accommodations, a vocational counselor from Intracorp, a CIGNA subsidiary, is alerted.
The case managers and nurses working with the patients on a day-to-day basis start discussing vocational rehabilitation services with the members as soon as they are stable.
"They keep us informed about the claimant’s ability to work so that when we start talking with the employers, we are aware of the claimant’s level of functioning and we have something to work with," Greene says.
As treatment progresses, the nurse case manager, vocational rehabilitation counselor, and claims case managers all work together as a team to see that seriously ill or injured members get the services they need.
"When you’re looking at someone on the road to recovery who is going to be going through physical and mental rehabilitation, vocational rehabilitation should be part of the plan from the outset," Greene adds.
One vocational rehabilitation counselor covers the cases handled by one long-term disability team that typically is made up of 10 case managers.
The vocational rehabilitation counselors and nurse case managers are located in the same office with a conference table in the middle of the room that they can use for team meetings.
"Their proximity alone helps with the communication and the timely transition of cases to the vocational rehabilitation counselor. They have daily case management sessions, both formal and informal," Greene says.
For instance, the case managers alert the vocational rehabilitation counselors when they feel a client is ready for return-to-work services and discuss what issues and obstacles they may face.
The nurse case manager, physician, and vocational rehabilitation counselor decide when a member is medically stable and ready to be turned over to vocational rehabilitation.
The frequency of the team meetings depends on the needs of the individual cases. Typical meetings may be weekly for short-term disability cases and bimonthly for long-term disability cases.
When a member is nearing return to work, the case managers, vocational rehabilitation counselors, and other involved parties — such as the employer or the state rehabilitation commission — are in touch more frequently.
"We have open, ongoing sessions with the entire team and often include physician advisers as well," adds Rose Marie Antonucci, MS, CRC, CCM, LPC, vocational rehabilitation counselor with CIGNA Group Insurance.
"The nurse case manager looks at the claimant’s progress, and whenever it looks like stability has been achieved and the claimant is moving nicely along, they present the case to the vocational rehabilitation counselor," Antonucci says.
Patients who are turned over to the vocational rehabilitation counselors have been seriously injured or have a debilitating illness and are on long-term disability.
The vocational rehabilitation counselors work with them over the telephone, helping them get back to work.
"We work to get an individual back to work doing a job that is most similar to the individual’s work experience. It may be the same job or a different job with the same employer or, if that can’t happen, we assist them in returning to work with a different employer," Greene explains.
When an employee simply can’t go back to his or her old job, the counselors look for transferable skills. For instance, if someone did volunteer work that involved data entry, they might suggest a data entry job.
Services could include resume preparation, help with improving interview skills, help with filling out applications, and career counseling to help guide the client to an appropriate goal.
"We also look at the possibility of short-term or long-term training," Green says.
Patients are not referred for vocational rehab counseling until they have recovered to the point that they have some functional ability to work.
When members need extra services and hands-on rehabilitation help, the CIGNA vocational rehabilitation counselors call in rehabilitation specialists at Intracorp, a CIGNA subsidiary.
"If we need someone to be face to face and hands-on, we call on the Intracorp staff. They can go on site and look at the job or accompany the client to the job to help alleviate their fears and make the transition back to work," Greene says.
As an Intracorp on-site vocational case manager, Cherilyn Montgomery, CCM, CRC, typically meets with the client in person and conducts an initial vocational assessment, looking at his or her abilities and goals and any challenges.
She does role-playing to help the client develop interview skills and develop a resume.
"When I am working with an individual, I consider myself a coach. The client does the hard part. They have to go out and do the interviewing and leg work. I make myself available in case they have any concerns or problems," Montgomery says.
If clients can’t go back to their old job, Montgomery conducts a transferable skill analysis to determine what other skills they have, helps them choose areas they are interested in, and does a labor market survey to see what skills are needed in their area.
"I give each client a concentrated effort, working with them on an individual basis. The ultimate goal is to get them back to work in a position that is satisfactory to them and within their interests," she says.
If members decline to participate in the vocational rehabilitation services, the counselors suggest counseling services.
"They may not be at the point that they are ready to do something. Vocational evaluation is part of determining if they are motivated. All we can do is offer the services and make them available," Montgomery says.
As a safeguard against people being reluctant to go back to work for fear that they will fail and lose their benefits, CIGNA’s long-term disability contract allows people to try to go back to work without losing their benefits.
"If there is a medical need to go back part time and increase their hours gradually, depending on the contract purchased by the employer, their earnings are offset without necessarily being off claim," Greene says.
In these cases, the vocational rehabilitation counselors put together a rehabilitation plan, making it clear to the client that their claim remains open.
"We convey to the claimant that they can go out and work and don’t have to be afraid they can’t handle it. If they have to leave the job for medical reasons, it doesn’t jeopardize their claim," Antonucci adds.
"It is very important to make the clients aware of the vocational services from the outset. They may not be immediately interested, but we make sure they know that vocational rehabilitation services are available to them in the future," she says.
Through a team approach that involves case managers, vocational rehabilitation counselors, and on-site job coaches, CIGNA Group Insurance has developed a successful return-to-work program for members who are severely injured or experience debilitating illnesses.Subscribe Now for Access
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